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Postpartum Hemorrhage of the Uterus

Uterus Hemorrhage Postpartum


Presentation

  • 652.8 affecting fetus or newborn 763.4 anteversion, cervix or uterus 654.4 atony, uterus 661.2 bicornis or bicornuate uterus 654.0 breech presentation (buttocks) (complete) (frank) 652.2 brow presentation 652.4 cephalopelvic disproportion (normally formed[icd9data.com]
  • Most women present with abdominal pain, postpartum hemorrhage, a visible vaginal mass or palpable mass at bimanual exam.[emergencymedicinecases.com]
  • Mothers present with features of anemia (e.g., lightheadedness, pallor) or hypovolemic shock (e.g., hypotension, tachycardia ).[amboss.com]
  • Ultrasound is not helpful in endometritis. [ 17 ] Management If sepsis is suspected in the community, urgent referral to hospital is indicated where 'red flag' signs and symptoms are present.[patient.info]
  • All material presented here is unclassified. C. 2009, 2014, All Rights Reserved[brooksidepress.org]
Physician
  • In surgery to control the hemorrhage, a physician must open the lower abdomen and tie off bleeding arteries to the uterus, repair the uterus or remove it entirely.[sciencedaily.com]
  • Manual exploration of the uterine cavity is carried out by the physician, to try to find the cause of PPH.[wikihow.com]
  • Am Fam Physician. 2007;75(6):875-882. Last reviewed June 2018 by EBSCO Medical Review Board Beverly Siegal, MD, FACOG Please be aware that this information is provided to supplement the care provided by your physician.[cancercarewny.com]
  • Leawood, Kan.: American Academy of Family Physicians, 2001.[aafp.org]
  • If the woman is experiencing respiratory distress, administration of oxygen at 4L/min via face mask could be prescribed by the physician.[nurseslabs.com]
Hypothermia
  • Forced air warming was used to prevent hypothermia. Injection 15 methyl PGF 2 α (Carboprost ) 250 µg was given intramuscularly with a repeat dose injected into myometrium.[apicareonline.com]
  • Other causes include placental implantation site in the lower uterine segment, bacterial toxins (eg, chorioamnionitis, endomyometritis, septicemia), hypoxia due to hypoperfusion or Couvelaire uterus in abruptio placentae, and hypothermia due to massive[emedicine.medscape.com]
Abdominal Pain
  • Most women present with abdominal pain, postpartum hemorrhage, a visible vaginal mass or palpable mass at bimanual exam.[emergencymedicinecases.com]
  • Abdominal pain. Offensive smelling lochia. Abnormal vaginal bleeding - postpartum haemorrhage. Abnormal vaginal discharge. Dyspareunia. Dysuria. General malaise. Look for history of extended labour, difficult third stage, ragged placenta, PPH.[patient.info]
  • Haematometra might present with amenorrhoea 33 and pyometria coupled with abdominal pain and fever, weeks or months postpartum. 34 The occurrence of uterine cavity synechiae causing uterine outflow obstruction has also been reported after compression[hkmj.org]
Hydrops Fetalis
  • fetalis 653.7 hypertension - see Hypertension, complicating pregnancy hypertonic uterine dysfunction 661.4 hypotonic uterine dysfunction 661.2 impacted shoulders 660.4 incarceration, uterus 654.3 incomplete dilation (cervix) 661.0 incoordinate uterus[icd9data.com]
Fracture
  • […] excessive face presentation 652.4 failure, fetal head to enter pelvic brim 652.5 female genital mutilation 660.8 fetal fetopelvic disproportion 653.4 fever during labor 659.2 fibroid (tumor) (uterus) 654.1 fibromyomata 654.1 forelying umbilical cord 663.0 fracture[icd9data.com]
Convulsions
  • Bradycardia, absent radial pulse and convulsions following intramyometrial vasopressin. J Anaesth Clin Pharmacol 2010;26:109-10.[apicareonline.com]
Screaming
  • Steady pressure with a fist on a relaxed patient (i.e. not screaming from the pain of what you are trying to do) whose uterus relaxes and gets re-inverted. Nitro can be used to relax the uterus but her BP will drop through the floor.[emergencymedicinecases.com]
Vaginal Bleeding
  • There was minimal vaginal bleeding during the following 8 hours, so the pack was removed. The patient had no further complications and was released 3 days after delivery.[ncbi.nlm.nih.gov]
  • bleeding, the mother's condition is unaffected as blood loss occurs only in the fetus.[amboss.com]
  • bleeding and painful contractions.[mountsinai.org]
  • Heavy vaginal bleeding. Bleeding of more than 500 mL in a normal vaginal delivery and more than 1000 mL in a cesarean birth qualifies for a postpartum hemorrhage. Tense and rigid uterus.[nurseslabs.com]
  • Call your healthcare provider right away if you have a lot of vaginal bleeding, especially if you have clots in the blood. How can I help prevent severe postpartum bleeding? There is no sure way to prevent postpartum hemorrhage.[summitmedicalgroup.com]

Workup

  • Liver and renal function tests as well as coagulation workup revealed no abnormalities. In the delivery room, the patient was administered 2 units of packed platelet concentrate in around 30 minutes before giving birth.[f1000research.com]
Polyps
  • SECONDARY POSTPARTUM HAEMORRHAGE Aetiology Retained parts: of the placenta, membranes, blood clot or formation of a placental polyp.[gfmer.ch]
  • […] prolapse of umbilical cord 663.0 oversize fetus 653.5 pathological retraction ring, uterus 661.4 pelvic penetration, pregnant uterus by instrument 665.1 perforation - see Delivery, complicated, laceration persistent placenta, placental polyhydramnios 657 polyp[icd9data.com]

Treatment

  • While these results are promising, Shin stressed the necessity to explore the impact of the treatment on future fertility.[sciencedaily.com]
  • Once we've approved your claim, you'll get the private treatment you need. 3 And we’ll pay for treatment After you've been treated, send us your invoices.[aviva.co.uk]
  • One must quickly work through the differential causes and rapidly initiate treatment.[clinicaladvisor.com]
  • Many obstetricians choose rectal misoprostol alone or in combination with oxytocin as the preferred treatment of PPH.[mdedge.com]
  • Medical Treatment Uterine massage Oxytocin (Pitocin) infusion Ergot derivatives (ergonovine, ergometrine) Prostaglandin F2α (carboprost tromethamine) Interventional Treatment Selective angiography Vasopressin infusion Surgical Treatment Uterine curettage[gbmedlaw.com]

Prognosis

  • Standard of Care and Prognosis Close monitoring is the best route for PPH. The mother's condition, skin color, blood pressure, blood loss, uterine size and tone are closely assessed.[defranciscolaw.com]
  • Prognosis 90% of cases of postpartum endometritis treated with antibiotics improve within 48-72 hours. [ 16 ] If this is not the case, the patient should be re-evaluated.[patient.info]
  • Prognozis Prognosis of PPH depends mostly on the cause, but the underestimation of blood loss, delaying diagnosis and treatment may lead to a life threatening situation. References 1. American College of Obstetricians and Gynecologists.[folk.uio.no]
  • Prognosis and outcome A. Maternal/fetal outcomes PPH is still a leading cause of maternal morbidity in the United States. Institution of protocols for the treatment of postpartum hemorrhage can reduce mortality associated with hemorrhage. B.[clinicaladvisor.com]

Etiology

  • […] placental delivery Blood loss 1000 mL for cesarean section occurring at any time, either before, during, or after placental delivery Primary PPH (most common): blood loss within 24 hours Secondary PPH: blood loss from 24 hours to 12 weeks postpartum Etiology[amboss.com]
  • Diagnostic maneuver Etiology Therapeutic Maneuver Uterine palpation Uterine atony Blood for typing and cross-maching Establishment I/V infusion system (1 or 2) Uterotonic agents Indwelling urinary catheter Oxygen through mask Massage of the uterus Bimanual[folk.uio.no]
  • The differential diagnosis for the etiologies of early PPH include: Uterine atony Lacerations Retained placenta Uterine inversion Uterine rupture Examination is key to revealing the etiology. Bimanual pelvic exam will identify uterine atony.[clinicaladvisor.com]
  • Treatment varies depending on the etiology, and clinicians need to know the optimal assessment methods to determine the cause.[effectivehealthcare.ahrq.gov]
  • Bleeding related to spontaneous abortion may have etiologies and management in common with those for PPH.[emedicine.medscape.com]

Epidemiology

  • […] issue, T hrombin References: [1] [2] Uterine atony Definition : failure of the uterus to effectively contract and retract after complete or incomplete delivery of the placenta, which can lead to severe postpartum bleeding from the myometrial vessels Epidemiology[amboss.com]
  • Epidemiology Obstetric haemorrhage is no longer a major cause of maternal death in the UK.[patient.info]
  • […] oxytocin as part of the active management found similar benefits with giving it before or after the expulsion of the placenta. [42] There is no good quality evidence on how best to treat a secondary PPH (PPH occurring 24 hrs or more after the birth). [43] Epidemiology[en.wikipedia.org]
  • Epidemiology of postpartum haemorrhage: a systematic review. Best Pract Res Clin Obstet Gynaecol 2008 Dec;22(6):999-1012. PMID: 18819848. Calvert C, Thomas SL, Ronsmans C, et al.[effectivehealthcare.ahrq.gov]
  • Epidemiologic profile of maternal deaths in two referral hospitals in Cameroon. Open J Obstet Gynecol. 2016;06(06):365–72. View Article Google Scholar World Health Organization.[bmcpregnancychildbirth.biomedcentral.com]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology There are different main causes of postpartum hemorrhage, and they cause bleeding in different ways. In uterine atony, the uterus stops contracting, which leads to bleeding because the placental sites have closed.[nurseslabs.com]
  • If it does, there is probably other pathophysiology occuring. At this point an obstetric consultant should be contacted in the event that high acuity medical or surgical procedures are needed.[library.med.utah.edu]
  • Pathophysiology Over the course of a pregnancy, maternal blood volume increases by approximately 50% (from 4 L to 6 L).[emedicine.medscape.com]

Prevention

  • Buzolits, Anna; Geshwender, Sarah; Petri, Taylor; Toor, Jordan Abstract: The project focused on creating a method of prevention for postpartum hemorrhage (PPH) in low-income hospitals.[deepblue.lib.umich.edu]
  • Again prevention is critical regarding PPH.[sharinginhealth.ca]
  • In settings in which reliable refrigeration is not available, misoprostol, a medication that is heat-stable, is often used to prevent and treat PPH.[mdedge.com]
  • Other risk factors include obesity, fever during pregnancy, bleeding before delivery, and heart disease. [7] Prevention [ edit ] Oxytocin is typically used right after the delivery of the baby to prevent PPH. [2] Misoprostol may be used in areas where[en.wikipedia.org]
  • Although risk factors and preventive strategies are clearly documented, not all cases are expected or avoidable.[aafp.org]

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